Three Nation Approach to Reducing Harm From Falls Keeping older people safe in our care Lorraine Lovitt NSW Falls Prevention Program Clinical Excellence Commission September 2017
NSW has over 7.7 million people over an area three times the size of the United Kingdom
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4 2015/16 Calls for falls to ambulance = 97,572 median 8,131 /month
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Fall rate per 1,000 separations Quarterly fall rate per 1,000 hospital separations by sub-category, NSW public hospitals, 65 years and over 2.0 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 Jul-Sep 2015 Oct-Dec 2015 Jan-Mar 2016 Apr-Jun 2016 Jul-Sep 2016 Oct-Dec 2016 Jan-Mar 2017 Intracranial injury Fractured neck of femur Other fractures Total falls 9
Figure 11 and 12: Falls by SAC1 & SAC2 and SAC3 & SAC4, July 2012 - December 2016 Caveat: * SAC1 data obtained from CEC RIB database, SAC2-4 data obtained from IIMS 10
IMS Data 09.00 10.30 13.00 14.30 16.00 & 18. 00 11
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From the patient s perspective Don t kill me Don t harm me Don t do things that cannot help me Reliably do things that can help me Relieve my pain physical and emotional Don t make me feel helpless Share information Don t make me wait Don t waste money Dr Don Berwick
Clinical Excellence Commission The Clinical Excellence Commission promotes and supports best practice clinical care, safety and quality across the NSW health system by: conducting high-level analysis and reviews that identifies risks and opportunities for improvement providing expert support, advice, tools and information working collaboratively with patients, clinicians, managers, health service partners and the broader community. 14
Building blocks
Care of the older person in hospital Boards: leading through strategic direction, governance, risk management, financial and quality and safety Executive: building capability and supporting frontline teams in improvement whole of hospital targeting Engagement with patients, families and carers Expert clinical/improvement leads and teams: nursing, medical and allied health improve clinical processes All ward staff: practice reliable falls prevention/care 16
Medical Conditions Stroke Incontinence Parkinson s disease Dementia Delirium Medications Psychoactives Polypharmacy Risk factors for falls Sensorimotor & Balance Muscle weakness Impaired vision Reduced peripheral sensation Poor reaction time Impaired balance Falls Psychosocial & Demographic History of falls Depression Advanced age Living alone ADL limitations Female gender Inactivity Poor nutrition Environmental Poor footwear Home hazard External hazard Inappropriate spectacles Neuroscience Research Australia 2012 17
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CEC support What are the contemporary skills required to deliver safe care? Reliable & sustained interventions Cognitive impairment dementia /delirium Mobility safe mobilisation Medication review, reconciliation and reduction Intentional Rounding /toileting plan Multi-disciplinary team collaboration Huddles/team talks and clinical handover
Falls in hospital Fall Risk Screen Fall Risk Assessment & Management Plan Improving communication Clinical Handover 20
Hospitalised older people with dementia Few people with dementia are admitted for dementia-related reasons Common reasons for admission are: Falls-related injuries e.g. hip fractures & head injuries (3 times as common) Infections e.g. UTIs, pneumonia Circulatory problems e.g. stroke, dehydration
PRESENTATION NAME MONTH YYYY PRESENTER NAME 23
Why are confused older people falling? Environment is different from home 24
Press here!
Post Fall Immediate response (Assessment & observations) Ongoing observations & monitoring Communicate Document Key conditions to be on alert for: Delirium Head injury monitor patients on anticoagulants Sepsis Post Fall Huddles 27
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Mobility Resources Introduction to balance & strength exercises Safe us of mobilising equipment 30
Mobility Resources 31
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Evaluation of Falls in Hospital - KPI Triple aim - improved patient and staff experience, outcomes (health of the public) and efficiency & effectiveness of care LBVC KPI: Aim: 5% reduction in hospital falls leading to intracranial injury, fractured neck of femur or other fracture per 1000 occupied bed days (ACSQHC Hospital Acquired Complication data set) From July 2018? no funding for Hospital Acquired Complications including from falls in hospital
Falls in Hospital Timeline 2017/18 Workshop 1 in Sydney Workshop 2 in Sydney Workshop 3 in Sydney 18 25 28 30 22-23 13-14 31-1 21-22 26-27 27-28 Sept Oct Nov Dec Jan Feb March April May Jun Tri Nations Falls Expert Workshop 2018 Other Workshops being held in 2017: 24 th August - Mental Health and Falls Prevention 20 th October - Aged Care Collaborative Forum 23 rd October Delirium Master class: Professor Sharon Inouye November MNCLHD Rural Forum December MLHD Rural Forum Coaching Calls
CEC support Quality and Safety Improvement Capability through QI Academy: http://www.cec.health.nsw.gov.au/getinvolved/events-and-webinars/calendar Clinical practice improvement, basic and advanced measurement techniques and tools Includes training for staff on screening and assessment for falls risk, clinical team communication and teamwork and medication safety and reconciliation
Care of the older person in the community Opportunistic case finding in primary and secondary care settings Older people in contact with health professionals are to be asked routinely whether they have had a fall in the past year and observed for balance and gait deficits regardless of the health care setting in which they present. And are to be offered interventions to manage fall risk and in particular where they will benefit from balance and strength training as appropriate Older people who present for medical attention because of a fall, or report recurrent falls in the past year, or demonstrate abnormalities of gait and /or balance are to be offered multifactorial fall risk assessment & individualised interventions 36
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CEC Resources 39
Equipment Installation and safe use guides 40
Patient, family & carer as integral team members Refocusing care delivery around the patient improves the patient care experience & clinical & operational outcomes: decreased adverse events including falls 36.4% reduction in falls by patients with dementia by the sixth month of using TOP 5 We need to think of the patient and their family as integral members of the healthcare team. Once you ve gotten mileage out of your systems, then the next level of improvement you can only do by engaging the patient Professor Tom Delbanco, Inaugural Chair, Picker Institute, BIDMC Physician, Boston Harvard Medical School
Created by nurses at Guy's and St Thomas Barbara's Story is a series of 6 films which has changed attitudes to dementia in hospitals across the world see complete video at: http://www.guysandstthomas.nhs.uk/newsand-events/2014-news/20140331-barbarasstory-youtube.aspx
Patient stories CEC YouTube VIDEOS 43
www.activeand healthy.nsw.gov.au As of 30 June 2017, there were 825 program providers & 850 exercise program s 785 of these are registered as fall prevention programs & 65 are registered as general physical activity programs. Google Analytics 31 March 2016-31 March 2017 Number of page views 215,535 Number of sessions 48,467 Number of users 35,644 Average number of pages viewed per session 4.41 Percentage of sessions accessed in NSW 89.8% 44
Promoting active communities (to prevent falls) www.activeandhealthy.nsw.gov.au Health and lifestyle checklist How to get up from a fall Exercises to do at home Home safety checklist DVD Home based exercises
State-wide investment to build capacity 2038 Stepping On programs have been delivered throughout the state in more than 12 languages 21,954 participants have completed the program as at (June 2017) (Stepping On Clemson & Swann)
Support to Rural Volunteers to deliver Tai Chi and Physical Activity Programs NSW Health - get healthy 47
Trish Nove and Kitty Kaur Centre for Population Health Falls Prevention, WSLHD
Partnership Structure
Oldest Flash Mob - Blacktown 50
Care of the older person in residential aged care Vitamin D supplementation Medication review Multidisciplinary intervention 51
Research Projects http://sydneynorthhealthnetwork.org.au/partnerships/isolve-project/ Professor Lindy Clemson Dr Kim Delbaere Standing Tall home based exercise program https://www.neura.edu.au/clinical-trial/standingtall-home-based-balance-exercise-program/ 52
NSW Falls Prevention Network Network list serve Newsletters & updates Annual Network forum held 19 May 2017 http://fallsnetwork.neura.edu.au
Take home message We all have a role to play in Keeping Older People Safe in Our Care Looking for clinical improvement in how we provide this care and work together Acknowledgement the great work already underway in this region 54
Thank you Questions For further information: lorraine.lovitt@health.nsw.gov.au www.cec.health.nsw.gov.au PRESENTATION NAME MONTH YYYY PRESENTER NAME 55